Gender differences in the management of Acute Coronary Syndromes (ACS) have been described regarding delays before reperfusion and treatment procedures.

To compare medical care between genders in patients hospitalized for a first episode of ACS in the 3 French MONICA Registries.

The French MONICA registries based in three administrative regions were used to establish a cohort of 1,156 patients aged 35–74 hospitalized for a first episode of ACS between October 1st of 2015 and March 31st of 2016, and without history of previous coronary heart disease.

In this cohort, 25.7% of patients were women (N=297). They were significantly older than men, with a median age of 61 versus 59 (P=0.02). No gender differences were observed in delays from symptoms onset until first medical aid or hospitalization. In most cases, both men and women were addressed directly to the hospital (37.9% and 43.4% respectively). When a pre-hospital medical aid was requested, women were more often referred to an Emergency Department (54.9% vs. 40.2%), while a higher proportion of men were addressed to an Intensive Care Unit (27.5% vs. 18.9%) or to an operating room (27.7% vs. 21.3%, P=0.01). Coronarography was performed in 93.3% cases of women versus 98.0% of men (P<0.001). As compared with women, men suffered from more severe coronary lesions, resulting in a higher proportion of revascularization procedures (83.6% vs. 65.2%, P<0.001). Basic drug prescription did not differ between genders. At discharge, women were less frequently scheduled for cardiac rehabilitation (32.7% vs. 43.0%, P<0.01) or a complementary revascularization (9.2% vs. 15.3%, P=0.01).

Care trajectories differed between men and women, even though this did not seem to lengthen delays of care. Differences were also observed for diagnostic management and prescription of cardiovascular rehabilitation. The age profile of women may partially explain this differential care.